Archive | November 2013

Let’s add a new doctor to the mix

Yesterday, I had a consultation with a breast surgeon, specifically Dr. Kang. Now that I know I’m getting a mastectomy in a few weeks, I need to make a decision on reconstruction. I met with Dr. Kang mainly to get information on the procedure to help me decide on the best choice.

Dr. Kang laid out a whole series of decisions for me. First off, I need to decide on whether I want to do reconstruction or not. If I do decide to do reconstruction, I then have another set of questions to answer – do I have the reconstruction at the same time as the mastectomy or do I wait until later? Do I use my own tissue or an expander for the reconstructed breast? Do I reconstruct just the right breast (which needs to happen due to cancer) or both?

Dr. Kang couldn’t help me too much on the ultimate decision to reconstruct or not, but he did provide me with lots of information on the process and the other decisions. He recommends reconstruction at the same time as the mastectomy. There are multiple advantages of doing the reconstruction immediately. For one thing, there’s just the single surgery so just one anesthesia and one recovery. It does make the surgery longer, but doesn’t add much in terms of risk. There’s a psychological benefit – you go to sleep with breasts, and wake up and still have something on both sides (not something I’m worried about, but can be important for some people). Lastly, the surgeon can take advantage of the natural landmarks (they look for the inframammary fold) during the reconstruction to create a more natural breast, and the skin is more pliable during the expansion process.

There are two choices for reconstruction – the surgeon can use your own tissue, or an expander. If you use your own tissue, they typically pull fat tissue from your stomach and use skin from your back. It does make for a longer operation, provides another spot to heal, and could result in a hernia or abdominal weakness. If they use an expander, you have to go in for weekly visits to add saline to the expander and stretch the skin over the expander until you’re happy with the new cup size.

Finally, the question of one or two implants. If you only get an implant on one side, it tends to look a bit off over time. For symmetry purposes, it’s best to replace both breasts.

So, now that I have all that information, I have to decide what I want to do.

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Good news!

I saw the breast surgeon (Dr. Engel) today, and there was good news. The latest breast MRI came back completely clear of cancer. My oncology team had a meeting this morning to talk about my case and they were all quite impressed with how well the cancer responded to treatment. Needless to say, I’m extremely excited!

Unfortunately, it doesn’t change the surgery I have planned. I still need a modified radical mastectomy. Because of the size of the initial tumor, Dr. Engel will remove all of the right breast tissue and most of the axillary lymph nodes. Since I had a biopsy that verified the cancer had spread to the axillary lymph nodes, he’ll take most of them out just to be safe. I just have to decide if I want to do reconstruction on the breast or not. I’m having a hard time making a decision on that. I will meet with the plastic surgeon to get some more details and maybe that will help.

Once surgery is done, the pathologist will look through the tissue for any evidence of the cancer. If I’m really lucky, and there’s no pathological evidence of the cancer, I won’t even have to do radiation! That would be pretty awesome, but I’m not counting on it. Just having it not show up on the MRI improves my long-term outlook, and makes me quite happy today.

Odd side effects

So, now that I’m not feeling any of the side effects of chemo, I consider myself officially done! There is much rejoicing!! I thought I’d do one last post on chemo, specifically on the unexpected and odd side effects I experienced with chemo. Everyone knows about the hair loss, nausea and vomiting, and impacts on the blood cells, but there’s more to it than those symptoms.

For example, I never lost all of my hair. Most of my head hair fell out, and I haven’t had to shave since I started chemo (a small benefit), but I never lost any of my arm hair or my eyelashes. Eyebrows did end up going. At least my hats have a low brim, and you couldn’t see the lack of eyebrows too obviously. The one place I really missed hair (besides my cold back of the neck) was in my nose. Not having nose hair caused a surprising amount of annoyance, mainly associated with the dripping of snot. There just wasn’t any hair to slow down the trip of that snot out of my nose.

Notice the stripes on my nails

Notice the stripes on my nails

One odd side effect was the impact of chemo on my fingernails. If you look closely in the photo, you might be able to see the stripes on my nails. All of my fingernails have four white, horizontal stripes on them, corresponding to a cycle of chemo. I’m fairly certain that there will be six stripes by the time the nails grow out. At least I never lost the nail. I’ve heard from some other friends who went through chemo that they lost fingernails or toenails.

Finally, and this one might be TMI but it’s for posterity and so others know what to expect, I stopped menstruating. It was most surprising because I specifically asked at our chemotherapy orientation meeting if that would happen and the nurse said no. It may or may not be permanent. I’m not really worried about it, since I’m done having kids and it’s one less hassle to deal with while undergoing chemo, but it was unexpected.

And those were some of the odd things chemo did to me. Hopefully, no long-term impacts (beyond eliminating the cancer).

Third time’s a charm

I had my third (and last, for a while I hope) breast MRI yesterday. Dr. Li ordered it to see if that last little bit of cancer is gone after three more cycle of chemo. I am trusting that it is, but I’ll find out the result when I meet with Dr. Engel, the surgeon, next week.

Yesterday was the beginning of the upswing from chemo, but I still felt a bit nauseous. This particular cycle has been a little higher in the nausea than many of the previous ones. I didn’t think anything about it, though, until I had to lay on my stomach for 20 minutes inside the MRI. Not the most comfortable of positions. Even worse, it was actually warm inside the MRI room. By the time I was done, I felt a bit light-headed. The room was all sparkly for at least five minutes. I got a glass of cold water and put my head between my knees for a minute or two and felt much better. The higher level of nausea didn’t really go away until I got home and took some meds, though.

Here’s what my MRI machine looked like:

Machine set up for breast MRI

Machine set up for breast MRI

I wanted to get a photo of the apparatus they use to capture breast tissue, but the magnets from the MRI would have fried my iPod if I had taken it into the room. This photo was taken from the door. I lay on my stomach on the bed projecting from the MRI, with my forehead cradled on a foam structure. You can just see the cutout for the right breast curving below the head support (there’s a similar hole for the left breast). Arms go over the head (see the grey rectangular pad for an arm on the upper left of the bed), and you slide into the MRI. They hook up your IV to be able to add the gadolinium for contrast, and listen to clonking and whirring for 20 minutes or so. Relax as much as possible since the MRI captures more tissue if you’re relaxed than if you’re tense.

The other item of note was the pattern for my gown – it was different from last time.

photo(15)

Not too bad, although gray really isn’t a festive color. At least we get some spots of red for cheer.

Linked by Pink meeting

I got lucky this month that the Linked by Pink meeting was the night before chemo instead of the week after (especially since that Wednesday after chemo is a rough day). It was out in Fairview this time, which is a bit of a drive, but totally worth it since it was at a tea shop. Turns out, one of ladies in Linked by Pink owns a tea shop – Miss Bridget’s Spot of Tea! I didn’t even know there was a tea shop in the area, let alone one run by a friend.

This is the tea awaiting you at Miss Bridget's - so many choices to smell and taste!

This is the tea awaiting you at Miss Bridget’s – so many choices to smell and taste!

I totally love tea so I was sure to bring my wallet with me so I could come home with some new tea varieties. I was not disappointed. I picked up two green teas – a Balinese Rainbow Jasmine because I like jasmine tea and was out at home and then Genmaicha Yamasaki, which has toasted rice in it. I’ve seen it before and wasn’t sure about the flavor, but decided to try a bit of it. I also grabbed a fruit tisane (Lady Hannah’s) for the kids.

I was also there for the support of the other Linked by Pink women (although the warm cups of tea didn’t hurt). Since I’m moving on to the next stage of treatment, it was time for me to ask lots of questions again. I was mostly interested in what the ladies did if they had a mastectomy. Did you have reconstruction? What kind? How did it work? Do you have a prosthetic? What’s it like? I’m just trying to figure out my options and get an idea of how it all works in real life, versus what the surgeon might say to me. I am in a bit of a holding pattern until I find out what the surgeon plans, but I want to be able to start thinking about options. Needless to say, there’s lots of thoughts floating through my head. We’ll see what happens soon enough, I know.

Baby, It’s Cold Outside

I must say, with the change in weather, I’ve noticed the cold a lot more than I used to. The back of my neck, particularly, feels the cold air. It’s really not used to being exposed this time of year. The only time I used to have my neck bare was in the summer when it was really hot and sweaty. My hats keep the top of my head nice and warm, but my neck feels left out. The one advantage of the cold weather is it’s easy to cool off when I get a hot flash – just pull the hat off for a couple of minutes and I cool right down.

Amazingly, my hair is already starting to grow back on my head. It never really all fell out, but it’s definitely thicker now than it was a month ago.

Fuzzy head

Fuzzy head

The sad part is you can’t really see it yet. It’s nice and fuzzy, and there are some longer bits of where it wasn’t shaved too tight to my head, but it’s still baby fine. Miss Curiosity asked me today when I would stop wearing my hats, and my answer is when I can not see scalp on my head. As you can see in the picture below, the scalp is pretty evident. I wish it would regrow the way StatsGuy’s hair does – nice and dark.

Fuzzy head and eyebrows

Fuzzy head and eyebrows

The other advantage of the hats is they hide my lack of eyebrows. All but a few eyebrow hairs managed to fall out, but there’s a sprinkling of regrowth (you can kind of see it in the picture above). I’m half tempted to just pull the long hairs out so everything is even as it regrows. At least I’m done with chemo and everything can start to regrow together. I haven’t minded the lack of body hair, but I would like the facial hair to come back quickly. We’ll see if the eyelashes fall out – I’ve heard from several friends who went through chemo that they lost their eyelashes weeks after chemo ended.

Last chemo!!!

You can’t see me, but I’m doing a little chair dance today. My last cycle of chemo is currently infusing to my body, and I am very happy about that. I won’t consider chemo to be over until all the side effects have cleared out, but today is a momentous occasion nonetheless. I will continue to come to the RCC every three weeks for a year in order to get my Herceptin infusions, but that is a biological and not chemo. Those infusions will be much easier than chemo. The infusion itself is only 30 minutes, I won’t need bloodwork or to meet with Dr. Li prior, and I won’t see all the chemo side effects.

This is the IV stand an infuser for the eight drugs I get each chemo cycle.

This is the IV stand an infuser for the eight drugs I get each chemo cycle.

I met with Dr. Li yesterday to get the results of my blood work and MuGA test. My red blood cell count, hemoglobin and hemocrit all came back higher. They’re still lower than the normal range, but higher than I’ve had in the past. My liver enzymes are still high, but at least they didn’t go up. I was disappointed the levels didn’t go down, since I was good and didn’t do too much physically this time. Dr. Li said I was fine, though, since they were stable and the other liver measurements were within normal ranges. My MuGA came back with my heart function at the maximum measurable level

StatsGuy came with me to chemo since it was the last one, and we celebrated just a bit by ordering lunch from the Panera in the plaza across the street.

Me and StatsGuy sitting at the RCC

Me and StatsGuy sitting at the RCC

Now that chemo is about done, I’m moving on to the next treatment – surgery. I meet with Dr. Engel two weeks from today to find out how much surgery he’ll be doing and the time frame. I’m hoping for early December for the surgery – StatsGuy won’t be teaching and I have family events scheduled for Christmas.